Stress Fractures

What are they?

As the name implies, a stress fracture is a break in the bone, which results from cumulative and/or repetitive strain to a particular site. These fractures are most commonly seen affecting the long bones or metatarsals of the foot. More specifically, they seem to involve most often, the three middle metatarsals with the second metatarsal being to most common. Pain in varying degrees is usually the chief complaint and it may or may not be accompanied by swelling and discoloration. A lump or soft tissue enlargement is frequently present over the site involved. Stress fractures are often problems because of their tendency to be missed or neglected. In most cases of metatarsal stress fractures, the actual bone break does not show on a regular x-ray for about ten days to two weeks from its onset. These fractures should be identified as soon as possible and properly managed by a specialist in order to insure a good result and prevent unnecessary disability.

What causes them?

The main cause of a stress fracture is that of cumulative or repetitive strain to a particular bone site. A long day on cement floors at a mall, an unusually hard hike or exercise walk, or maybe a long march in the military or as a member of a marching band can all qualify as possibly overstressing a metatarsal bone leading to a fracture. Cumulative strain to a particular site involves smaller stress loads that are repeated over a lengthy period of time. Either heavy strain for a short time period or lighter loads repeated over a longer time period can produce localized stress fractures. Usually, an x-ray taken after about ten days from the injury onset will identify the fracture site. Occasionally, more sophisticated tests are performed such as bone scans which are capable of making an earlier diagnosis.

How do you treat them?

A stress fracture is treated in much the same manner as most any other bone break. The area involved must be protected, supported, and immobilized to some extent. Motion at the fracture site has to be controlled so as to allow proper healing to occur. In most cases, a protective fracture shoe is used to accomplish these goals. The patient should limit his or her walking and should be followed up by a foot specialist to monitor the healing process.